静脉用蔗糖铁联合促红细胞生成素治疗肾性贫血患者的疗效观察

Objective To determine the efficacy and safety of intravenous iron sucrose and oral iron dextran in renal anemia patients. Methods Sixty renal anemia patients were randomized into two groups:intravenous iron group(IV group, 100 mg iron sucrose twice a week) and oral iron group(oral group, 150 mg iron dextran every day). The changes in hemoglobin (Hb),hematocrit (Hct),serum ferritin (SF),and transferrin saturation (TSAT) were assessed on week 4,8, and 12 after treatment. The maintenance dosages of erythropoietin (EPO) after reaching treatment target and the adverse events were also observed. Results Hb increased after treatment in IV group [(79.87 ± 13.19) g/L to (106.11 ± 12.38) g/L] and oral group [(85.41 ± 11.49) g/L to (94.68 ± 10.06) g/L],and compared with that before treatment, there was significant difference in each group(P< 0.01 ). Also significant difference showed in Hb levels after treatment between two groups(P< 0.01 ). SF and TSAT levels were higher after treatment in IV group than those in oral group (P < 0.01 ). The adverse event was lower in IV group (0) than that in oral group (16.7%,5/30).Conclusions Oral iron dextran which has more adverse events and poor efficacy in curing anemia, can not correct anemia ideally. Meanwhile intravenous iron sucrose has positive effects on renal anemia with low adverse events, and it can be used as a long term iron supplementation in hemodialysis patients.     

静脉用蔗糖铁联合促红细胞生成素治疗肾性贫血患者的疗效观察

Objective To determine the efficacy and safety of intravenous iron sucrose and oral iron dextran in renal anemia patients. Methods Sixty renal anemia patients were randomized into two groups:intravenous iron group(IV group, 100 mg iron sucrose twice a week) and oral iron group(oral group, 150 mg iron dextran every day). The changes in hemoglobin (Hb),hematocrit (Hct),serum ferritin (SF),and transferrin saturation (TSAT) were assessed on week 4,8, and 12 after treatment. The maintenance dosages of erythropoietin (EPO) after reaching treatment target and the adverse events were also observed. Results Hb increased after treatment in IV group [(79.87 ± 13.19) g/L to (106.11 ± 12.38) g/L] and oral group [(85.41 ± 11.49) g/L to (94.68 ± 10.06) g/L],and compared with that before treatment, there was significant difference in each group(P< 0.01 ). Also significant difference showed in Hb levels after treatment between two groups(P< 0.01 ). SF and TSAT levels were higher after treatment in IV group than those in oral group (P < 0.01 ). The adverse event was lower in IV group (0) than that in oral group (16.7%,5/30).Conclusions Oral iron dextran which has more adverse events and poor efficacy in curing anemia, can not correct anemia ideally. Meanwhile intravenous iron sucrose has positive effects on renal anemia with low adverse events, and it can be used as a long term iron supplementation in hemodialysis patients.     

血液灌注对维持性血液透析患者微炎性反应状态的影响

目的 探讨血液灌注(HP)对维持性血液透析(MHD)患者微炎性反应状态的影响.方法 50例行MHD治疗的慢性肾衰竭患者(MHD组),按随机数字表法分为两组:HP联合血液透析(HD)组(HP+HD组,25例)和单纯HD组(HD组,25例),并设对照组(25例).检测治疗前及治疗24周后血清高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平.结果 与对照组比较,MHD组血清hs-CRP[(6.72±263)mg/L 比(1.35±0.92)mg/L]、IL-6[(348.83±64.41)ng/L比(54.49±2247)ng/L]、TNF-α[(7.52±317)ng/L比(2 53±0.88)ng/L]水平明显增高(P＜0.05).治疗前HP+HD组与HD组血清hs-CRP、IL-6、TNF-α水平比较差异无统计学意义(P>0.05).治疗后,与HD组比较,HP+HD组血清hs-CRP[(4.78±2.49)mg/L比(6.89±2.69)mg/L]、lL-6[(260.54±56.72)ng/L比(357.14±56.37)ng/L]、TNF-α[(5.36±241) ng/L比(7.49±2.87)ng/L]水平明显下降(P＜0.05).结论 HP可改善MHD患者微炎性反应状态.

Abstract：

Objective To observe the effect of hemoperfusion on micro-inflammation in patients with maintenance hemodialysis (MHD).Methods Fifty MHD patients (MHD group) and 25 healthy volunteers (control group) were involved in this study.The MHD patients were divided into two groups by random digits table:hemoperfusion combined with hemodialysis group (HP + HD group,25 cases) and hemodialyais group (HD group,25 cases).The plasma levels of micro-inflammatory cytokines including high-sensitive C-reactive protein (hs-CRP),interleukin-6 (IL-6) and tumor necrosis faetor-α (TNF-α ) were measured before and after treatment.Results The plasma levels of hs-CRP,IL-6 and TNF-α in MHD group were significantly higher than those in control group [(6.72 ± 2.63) mg/L vs.(1.35 ± 0.92) mg/L,(348.83 ± 64.41) ng/L vs.(54.49 ±22.47) ng/L,(7.52 ± 3.17) ng/L vs.(2.53 ±0.88) ng/L](P＜0.05).There was no significant difference in the plasma levels of hs-CRP,IL-6,TNF-α before treatment between HD group and HP+HD group (P＞0.05),Compared with those in HD group,the plasma levels of hs-CRP,IL-6 and TNF-α after treatment in HP+HD group were significantly decreased [(4.78 ±2.49) mg/L vs.(6.89 ±2.69) mg/L,(260.54 ±56.72) ng/L vs.(357.14 ±56.37) ng/L,(5.36 ±2.41) ng/L vs.(7.49 ±2.87) ng/L] (P <0.05).Conclusion Hemoperfusion improves micro-inflammation in patients with MHD.     

ω-3脂肪酸对肝部分切除术后患者炎症反应和免疫功能的影响

目的 探讨ω-3脂肪酸对肝部分切除术后患者炎症反应和免疫功能的影响.方法 肝部分切除患者82例参加本研究,所有患者按随机数表法随机分为两组,术后给予等热量、等氮肠外营养治疗.对照组单纯使用中长链脂肪乳,研究组使用中长链脂肪乳联合ω-3脂肪酸.分别于术前、术后第1、3、7天抽取空腹静脉血,检测肝功能(总蛋白、白蛋白、前白蛋白、谷丙转氨酶、谷草转氨酶)、凝血功能(国际标准化比值)、免疫球蛋白(IgA、IgG、IgM)、CD3、CD4/CD8及外周血白细胞计数等.结果 术后第7天研究组患者血清总蛋白(61.40±5.12)g/L显著高于对照组(58.54±5.53)g/L(P=0.018),研究组谷草转氨酶(32.37±11.92)U/L显著低于对照组(42.50±29.97)U/L(JP=0.048),研究组IgA(2.67±1.01)g/L显著高于对照组(2.15±0.77)g/L(P=0.027),研究组IL-1β(7.88±6.45)pg/ml显著低于对照组(12.98±11.07)pg/ml(P=0.034),研究组IL-2(24.98±20.38)pg/ml显著低于对照组(43.09±20.74)pg/ml(P:0.002).两组患者术后第7天外周血白细胞及凝血功能指标差异无统计学意义.结论 ω-3脂肪酸有助于改善肝部分切除术后患者免疫功能及肝功能,降低炎症反应.

Abstract：

Objective To investigate the effects of ω-3 fatty acids (FA) on inflammatory reaction and immunologic function of patients after hepatectomy. Methods Totally 82 patients were randomized into control group and ω-3 FA group. Both groups received parenteral nutrition (PN) with equal nitrogen and calories. Patients in the control group received medium and long-chain lipid emulsion, and those in the ω-3 FA group received ω-3 FA combined with medium and long-chain lipid emulsion. Liver function test (serum total protein, prealbumin, albumin ,aspartate aminotransferase, alanine aminotransferase) , blood coagulation function (international normalized ratio) , immune globubin (IgA, IgG, and IgM) , CD3 and CD4/CD8 were measured on the first, third, and seventh post-operative day. Results Serum total protein in the ω-3 FA group [(61. 40 ±5. 12) g/L] was significantly higher than in the control group [(58. 54 ± 5. 53 ) g/L] (P = 0. 018 ) . Aspartate aminotransferase in the ω-3 FA group [(32. 37 ± 11. 92) U/L] was significantly lower than in the control group [(42. 50 ± 29. 97) U/L] (P = 0. 048). IgA in the ω-3 FA group [(2. 67 ± 1. 01) g/L] was significantly higher than in the control group [(2. 15 ±0.77) g/L] (P=0.027). IL-1β in the ω-3 FA group [(7.88 ±6.45) pg/ml] was significantly lower than in the control group [(12. 98 ± 11. 07) pg/ml] (P = 0.034). IL-2 in the ω-3 FA group [(24.98±20.38) pg/ml] was significantly lower than the control group [(43. 09 ± 20. 74) pg/ml] (P = 0.002). The white blood cell counts and coagulation function were not significantly different between two groups. Conclusion Total PN containing ω-3 FA can effectively improve immunologic function and liver function of patients after hepatectomy.     

希明婷片对卵巢功能低下所致骨质疏松症的疗效观察

目的 观察希明婷片治疗卵巢功能低下所致骨质疏松症的临床疗效.方法 将60例卵巢功能低下所致骨质疏松症患者按随机数字表法分为试验组(口服希明婷片治疗)和对照组(口服激素替代治疗),每组30例.分别于治疗前及治疗后6个月检测骨密度、骨钙素、雌二醇、卵泡刺激素(FSH)、子宫内膜厚度、血常规、尿常规、肝功能、肾功能.结果 试验组和对照组治疗后骨密度、骨钙素[骨密度:(0.606±0.059)、(0.617±0.065)g/cm2;骨钙素:(8.87±5.54)、(8.92±4.43)g/L]均较治疗前[骨密度:(0.537±0.068)、(0.552±0.073)g/cm2;骨钙素:(6.78±3.97)、(6.83±4.29)g/L]提高(P<0.05);试验组治疗前后雌二醇、FSH比较差异无统计学意义(P>0.05),对照组治疗前后比较差异有统计学意义(P<0.01).试验组疗效、主要症状总有效率分别为93.3%(28/30)、93.3%(28/30),对照组分别为90.O%(27/30)、86.7%(26/30),两组比较差异均无统计学意义(P>0.05).两组治疗前后血常规、尿常规、肝功能、肾功能比较差异均无统计学意义(P>0.05).结论 希明婷片对卵巢功能低下所致骨质疏松症的治疗效果明显并且安全.

Abstract：

Objective To observe the clinical effects of ximingting plan in treatment of osteoporesis result in hypofunction of ovary.Methods Sixty women with osteoporesis result in hypofunefion of ovary were divided into two groups by random digits table with 30 cases each.The investigated group received ximingting pian,the controlled group received hormone replacement therapy(HRT).The changes of bone density,bone gla protein(BGP),estradiol,follicle-stimulating hormone(FSH),the thickness of endometrium,blood routine,urine routine,liver function and kidney function before and after 6 months treatment were measured.Results Bone density and BGP after treatment wag higher than that before treatment in two (6.78±3.97)g/L;in controlled group:(0.617±0.065)g/cm2 vs.(0.552±0.073)g/cm2 and(8.92 4±4.43)g/L vs.(6.83±4.29)g/L](P<0.05).The levels of estradiol and FSH had no marked changes in investigated group(P>0.05);but not this in controlled group(P<0.01).The total effective rate of curative effect and presenting symptom was 93.3%(28/30),93.3%(28/30)in investigated group and 90.0%(27/30),86.7%(26/30)in controlled group,there was no significant difference between two groups(P>0.05).There was no significant difference in blood routine,urine routine,liver function and kidney function before and after treatment in two groups(P>0.05).Conclusion Ximingting pian is efficacious and safe in the treatment of osteoporosis result in hypofunction of ovary.     

胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床随机对照研究

目的 比较胃肠道手术后规范化序贯肠内肠外营养支持疗法与肠外营养支持的临床疗效.方法 采用随机数字表法,将126例拟行开腹胃肠道手术的患者随机分为早期肠内肠外营养支持疗法组(EEN+PN组,n=62)和肠外营养支持组(PN组,n=64),分别于手术前,手术后第3、7天监测患者的体重、体重指数、血清白蛋白、前白蛋白、血脂、血生化、血淋巴细胞计数、血C反应蛋白变化情况,比较两组患者术后胃肠道功能恢复时间、手术并发症、营养支持相关费用及住院天数.结果 术前两组患者的营养相关指标、血生化指标和炎症及免疫指标差异均无统计学意义(P>0.05);术后第3天,EEN+PN组患者前白蛋白水平显著高于PN组[(160.3±23.0)g/L比(137.0±28.7)g/L,P=0.000];术后第7天,EEN+PN组患者前白蛋白[(210.6±34.6)g/L比(154.8±36.9)g/L,P=0.000]、白蛋白[(33.6±3.8)g/L比(31.8±4.7)g/L,P=0.042]、淋巴细胞计数[(2.33±0.53)×109/L比(1.04±0.36)×109/L,P=0.046]水平均显著高于PN组,血γ-谷氨酰转肽酶[(48.12±33.84)U/L比(71.54±34.00)U/L,P=0.048]、C反应蛋白[(31.15±19.00)mmol/L比(45.90±23.21)mmol/L,P=0.042]、总胆固醇[(3.09±0.83)mmol/L比(3.29±0.91)mmoL/L,P=0.045]、低密度脂蛋白[(2.01±0.39)mmoi/L比(2.31±0.72)mmol/L,P=0.049]水平显著低于PN组.EEN+PN组患者术后胃肠道功能恢复时间显著短于PN组[(65.7±15.6)h比(75.1±27.0)h,P=0.036],围手术营养支持疗法总费用显著低于PN组[(2634.5±1306.8)元比(3058.6±1216.0)元,P=0.046].结论 胃肠道手术后早期规范化序贯肠内肠外营养支持疗法可以改善机体术后前白蛋白水平,有益于术后患者免疫功能和组织损伤水平的恢复,促进早期胃肠道功能恢复,降低营养支持疗法相关费用.

Abstract：

Objective To compare the clinical efficacy between standard sequential early enteral nutrition (EEN) plus parenteral nutrition (PN) and PN alone in patients undergoing gastrointestinal surgery. Methods Werandomly divided 126 patients who underwent laparotomy gastrointestinal surgery into EEN + PN group (n = 62) and PN group (n = 64). The levels of blood nutrition-related indicators, biochemical indicators, and inflammatory indicators were determined before surgery and 3 and 7 days after surgery, and the gastrointestinal function recovery time, complications, nutritional support cost, and length of hospital stay were compared between two groups. Results The preoperative nutrition-related indicators, biochemical indicators, and inflammatory indicators showed no significant differences between two groups (P >0. 05). Three days after operation, however, the levels of prealbumin in EEN + PN group were significantly higher than those in PN group [(160. 3 ±23. 0) g/L vs. (137.0±28.7) g/L, P=0.000]. Seven days after operation, the levels of albumin [(33.6±3.8) g/L vs. (31.8±4.7) g/L, P = 0.042], prealbumin [(210.6±34.6) g/L vs. (154.8 ±36.9) g/L, P=0.000], and lymphocyte cell count [(2.33±0.53) x 109/L vs. (1.04±0.36) × 109/L, P = 0. 046] in EEN + PN group were significantly higher than those in PN group, and the levels of serum γ-glutamyltransferase [(48. 12 ± 33.84) U/L vs. (71.54±34.00)U/L, P=0.048], C-reactive protein [(31.15 ± 19.00) mmol/L vs. (45.90 ± 23.21) mmol/L, P=0.042], total cholesterol [(3.09±0.83) mmol/L vs. (3.29±0.91) mmol/L, P = 0. 045] and low density lipoprotein [(2.01 ± 0. 39) mmol/L vs. (2. 31 ± 0. 72 ) mmol/L, P = 0. 049] were significantly lower than those in PN group. The postoperative gastrointestinal function recovery time in EEN + PN group was significantly shorter than that in PN group [(65. 7 ± 15. 6) hours vs. (75. 1 ± 27. 0) hours, P = 0. 036], and the total cost of perioperative nutrition in EEN + PN group was also significantly lower than in PN [(2634. 5 ±1306. 8) RMB vs. (3058. 6 ± 1216. 0) RMB, P= 0.046]. Conclusion Standard sequential EEN plus PN can increase the post-operative prealbumin level, improve the immune function, promote the recovery of gastrointestinal function, and decrease the cost of nutritional support.     

The immunogenicity and safety of 10 μg recombination yeast hepatitis B vaccine applied in expanded population

Objective To assess the feasibility of the 10 μg recombination yeast hepatitis B vaccine in the expanded applicable population group aged 5-18. Methods People with both HBsAg and anti-HBs negative were selected to take two-stage clinical experiment and the safety and immunogenicity were observed. Safety observation was conducted in 925 subjects, while 568 for immunogenicity. The observation group (aged 5-18) included 493 subjects, and (age>18) 75 enrolled in control group. For the observation group,there were three sub-groups including a child group (141, aged 5-6), early youth group(177, aged 12-13), and youth group (175, aged 16-18). Both groups were administered with 10 μg recombination yeast hepatitis B vaccines with 3 doses at 0 month, 1st month,6th month. To assess the immunogenicity,the vaccination reactions were observed during the following 4 weeks in order to assess the vaccine safety. The blood samples were taken during 4-6 weeks after fully vaccinated, and then anti-HBs were tested with RIA and analyzed by comparing the positive rate of anti-HBs,the geometric mean titer(GMT) and the protective rate between the two groups. Results Both observation and control group didn't show any general reactions,adverse events following immunization(AEFI) or coincidental cases when observed at 0. 5 h,6 h,24 h,48 h, 72 h, 1 week,2 weeks,3 weeks,4 weeks after being vaccinated. The result of serum test showed, the positive rates of child group, early youth group, youth group and control group were respectively 100. 00% (141/ 141),97.18% (172/177), 98. 29% (172/175) and 89. 33% (67/75); the GMTs of anti-HBs were respectively 440. 28,875.38,467.80,131.06 U/L; the protective rates were respectively 100. 00% (141/ 141), 97.18%(172/177), 97.14% (170/175) and 86. 67% (65/75). The positive rate, GMT and protective rate of the experimental group were all higher than that of control group(χ2<,positive rate>=12.77,5.12, 7.99; tGMT=3.89,4.13,5.91;χ2protective rate>=16. 81,8.60,8.44;P< 0.05). Conclusion This vaccine could be expanded to 5-18 year-old population with safety and effectiveness, the positive rate and protective rate of anti-HBs were both higher than that of control group.     

蔗糖铁注射液治疗老年缺铁性贫血疗效观察

目的 观察蔗糖铁注射液治疗老年缺铁性贫血(IDA)的疗效和不良反应.方法 选择32例老年IDA患者,按随机数字表法分为静脉组(17例)和口服组(15例),观察两种方法对改善贫血的疗效和不良反应.结果 治疗后静脉组及口服组血红蛋白(Hb)均较治疗前升高,分别为(100.18±8.71)g/L和(85.80±6.92)g/L,两组比较差异有统计学意义(P＜0.01);治疗后血清铁亦有上升,两组分别为(23.84±5.34.)μmol/L和(14.63±3.29)μmol/L,与治疗前比较差异有统计学意义(P＜0.01).静脉组无明显不良反应发生,口服组有6例(40%)发生胃肠道反应.结论 静脉用蔗糖铁可作为老年IDA患者补铁方式,疗效优于口服铁剂,且不良反应发生率低.

Abstract：

Objective To observe the effect and adverse reactions of iron sucrose injection in treating old patients with iron deficiency anemia(IDA). Methods Thirty-two old patients with IDA were divided into injection group(17 patients)and oral group(15 patients)by random digits table. The effects of improvement on IDA and their adverse reactions were observed. Results After treatment, hemoglobin(Hb)in the injection group and oral group was(100.18±8.71)g/L and(85.80 ± 6.92)g/L(P＜0.01), and serum iron was(23.84±5.34)μmol/L and(14.63±3.29)μmol/L(P＜0.01).There were no obvious adverse reactions in injection group, whereas there were 6 cases(40%)with gastric and colon adverse reaction in oral group. Conclusions The treatment of intravenous injection of iron sucrose can be effectively used to cure old patients with IDA. It has better effect and has lower rate of adverse reaction.     

自体骨髓单个核细胞移植治疗心绞痛的临床研究

目的 评价自体骨髓单个核细胞(BMMNC)移植治疗心绞痛的安全性和有效性.方法 15例不稳定型心绞痛患者在接受目前最佳药物治疗的基础上,于常规经皮冠状动脉介入治疗(PCI)后,进行冠状动脉内自体BMMNC移植,于冠状动脉病变近端注入自体BMMNC(BMMNC治疗组).随机人选16例不稳定型心绞痛患者,仅接受常规药物治疗和PCI(非细胞治疗组).以上所有患者于术前和术后6个月进行二维超声、单光子发射型计算机体层摄影(SPECT)和动态心电图检测.术中,术后3、6个月评价有无心肌梗死、心律失常等并发症和进行心绞痛的疗效评价.结果 未观察到因冠状动脉内注射BMMNC而导致的心肌梗死、心律失常等严重不良事件发生.术后3个月,BMMNC治疗组每周硝酸甘油用量变化显著低于非细胞治疗组、运动时间变化高于非细胞治疗组(P＜0.05).术后6个月,BMMNC治疗组每周心绞痛发作次数、每周硝酸甘油用量变化、加拿大心脏病学会(CCS)心绞痛分级变化均显著低于非细胞治疗组[分别为(12.6±9.3)次/周比(18.0±16.3)次/周,(-4.1±14.7)mg/周比(4.8±37 9)mg/周,(-1.4±1 0)级比(-0.8±1.7)级],运动时间变化高于非细胞治疗组[(2.5±1.3)min比(2.0±2.1)min](P＜0.05).结论 冠状动脉内注射自体BMMNC 治疗心绞痛是安全和有效的.

Abstract：

Objective To evaluate the safety and efficacy of transplantation of autologous bone marrow mononuclear cell (BMMNC) for angina.Methods Fifteen patients who had suffered from unstable angina were selected to receive intraeoronary transplantation immediately following percutaneous coronary intervention (PCI) with BMMNC (BMMNC group).Sixteen patients who had suffered from unstable angina only received treatment of regular medicine and PCI (non-BMMNC group).Two-D echocardiography,singlephoton emission computed tomography (SPECT) imaging and Holter monitoring electrocardiogram were checked up before and 6 months after the procedure.The complications of myocardial infarction,arrhythmia etc,efficacy for angina were evaluated during the procedure and 3,6 months after the procedure.Results The intracoronary injection of BMMNC did not result in myocardial infarction and arrhythmia during the transplantation.Efficacy parameters including nitroglycerine usage per week,exercise time 3 months after the procedure showed that BMMNC group were better than non-BMMNC group (P <0.05).Efficacy parameters including angina frequency per week,nitroglycerine usage per week,exercise time,and Canadian Cardiovascular Society class 6 months after the procedure showed that BMMNC group were better than nonBMMNC group[(12.6 ± 9.3) times/week vs.(18.0 ± 16.3) times/week,(-4.1 ± 14.7) mg/week vs.(4.8 ± 37.9)mg/week,(2.5±1.3)min vs.(2.0 ± 2.1) min, (-1.4 ± 1.0) grades vs.(-0.8 ± 1.7) grades](P＜0.05).Conclusion Intracoronary transplantation of autologous BMMNC is safe and efficient for angina.     

间歇应用去铁胺治疗老年人输血相关性铁负荷过重的临床研究

目的 观察间歇应用去铁胺对老年人输血相关性铁负荷过重的治疗效果及安全性.方法 23例老年输血相关性铁负荷过重患者应用去铁胺20～50 mg/(kg·d),最大剂量用至2000mg/d,加入0.9%氯化钠500 ml中,持续静脉滴注6 h,每4～6周连续应用5～6 d.结果 治疗9个月后,血清铁蛋白从治疗前(2771.5±735.3)μg/L下降到(2483.7±724.4)μg/L(P＜0.01),尿铁蛋白从治疗前(9.68±5.39)μg/L增加到(12.14±5.50)μg/L(P＜0.01).结论 间歇应用去铁胺治疗老年人输血相关性铁负荷过重能显著降低血清铁蛋白,且无明显不良反应.

Abstract：

Objective To evaluate the effect and safety of the intermittent deferoxamine therapy on relieving iron overload caused by transfusion in senile. Method Twenty-three senile with iron overload caused by transfusion were administered in a total daily dose of 20 - 50 mg/ ( kg·d ) for 5 - 6 days per week every 4 -6 weeks,the maximal dose was 2000 mg/d, add in 0.9％ sodium chloride 500 ml, continuous intravenous drip for 6 h. Result Nine months after therapy, serum ferritin fell from (2771.5±735.3)μg/L to (2483.7 ±724.4) μg/L (P＜0.01), and urine ferritin elevated from (9.68 ±5.39)μg/L to (12.14±5.50) μ g/L (P＜0.01 ). Conclusion It shows that intermittent deferoxamine therapy can reduce the serum ferritin with no significant toxicity.     

静脉用蔗糖铁联合促红细胞生成素治疗肾性贫血患者的疗效观察

目的 比较静脉用蔗糖铁与口服右旋糖酐铁治疗慢性肾衰竭患者肾性贫血的疗效与安全性.方法 将60例肾性贫血患者按照随机数字表法分为两组:静脉组静脉给予蔗糖铁100mg/次,每周2次;口服组给予右旋糖酐铁150 mg/d口服.观察治疗后4、8、12周血红蛋白(Hb)、红细胞压积(Hct)、铁蛋白(SF)和转铁蛋白饱和度(TSAT)等的变化,并观察治疗达标后不良反应发生情况.结果 治疗后静脉组Hb由治疗前(79.87±13.19)g/L上升为(106.11±12.38)g/L,口服组Hb由治疗前(85.41±11.49)g/L上升为(94.68±10.06)g/L,两组治疗前后比较差异均有统计学意义(P<0.01),且静脉组治疗后Hb水平明显高于口服组(P<0.01).静脉组治疗后血清SF、TSAT明显高于口服组(P<0.01).口服组发生不良反应5例(16.7%),静脉组无不良反应发生.结论 静脉用蔗糖铁治疗肾性贫血的疗效及安全性明显优于口服右旋糖酐铁.     

高通量血液透析对维持性血液透析患者免疫功能的影响

目的 探讨高通量血液透析对维持性血液透析患者体液免疫及细胞免疫功能的影响。方法 选择维持性血液透析患者60例,按随机数字表法分为常规透析组（C组）和高通量血液透析组（T组）,每组30例,治疗时间为12周,另选择20例健康成年体检者作为对照组（N组）,监测治疗前后患者外周血免疫球蛋白、补体C3、C4以及T细胞亚群的变化,同时观察患者治疗前后感染例次的变化。结果 C组患者治疗后外周血免疫球蛋白、补体C3、C4以及T细胞亚群水平较治疗前无明显变化,而T组患者治疗后外周血IgG、IgA、IgM、C3、C4、CD3+、CD4+、CD4+/CD8+水平较治疗前明显升高[(12.20±3.98) g/L比(6.18±1.45) g/L,( 1.89±0.58) g/L比(0.63±0.15)g/L,(1.29±0.47) g/L比(0.51±0.13) g/L,(0.94±0.36) g/L比(0.58±0.20)g/L,(0.28±0.06) g/L比(0.11±0.04)g/L,(63.11±9.43)％比(53.26±9.08)％,(38.21±6.15)％比(31.56±6.02)％,1.48±0.37比1.25±0.43]（P值均＜ 0.05）,且与C组患者治疗后比较,差异均有统计学意义(P＜0.05)。T组患者治疗后感染例次较治疗前明显降低[46.7％(14/30)比133.3％(40/30),P＜0.05],而C组患者治疗后感染例次较治疗前无明显变化[126.7％(38/30)比136.7％(41/30),P＞0.05]。结论 高通量血液透析可以改善维持性血液透析患者的细胞免疫及体液免疫功能,降低感染率。     

自体动静脉内瘘与带隧道带涤纶套导管对维持性血液透析患者贫血的影响

目的 分别探讨自体动静脉内瘘与带隧道带涤纶套导管对维持性血液透析患者贫血症状的改善效果。方法 选择2016年2月—2018年1月期间在我院治疗的72例维持性血液透析患者为研究对象,随机分为2组,各36例,内瘘组采用自体动静脉内瘘治疗,导管组采用带隧道带涤纶套导管治疗,比较两组治疗前以及治疗12个月后血红蛋白(Hemoglobin,Hb)水平以及C反应蛋白(C-reactive protein,CRP)水平。结果 内瘘组治疗前与治疗12个月后Hb水平为(73.02±8.79)g/L、(107.71±16.95)g/L,导管组为(72.35±8.16)g/L、(105.83±20.16)g/L,治疗前与治疗12个月后,两组患者Hb水平对比,差异无统计学意义(P>0.05);两组患者治疗12个月后Hb水平均高于治疗前,差异有统计学意义(P<0.05);内瘘组治疗前与治疗12个月后CRP水平为(15.17±3.86)mg/L、(5.08±2.13)mg/L,导管组为(15.21±3.75)mg/L、(5.87±2.49)mg/L,治疗前与治疗12个月后,两组患者CRP水平对比,差异无统计学意义(P>0.05);两组患者治疗12个月后CRP水平均低于治疗前,差异有统计学意义(P<0.05)。结论 对维持性血液透析患者而言,不同血管通路(自体动静脉内瘘与带隧道带涤纶套导管)均可有效缓解贫血症状,减轻微炎症状态。     

促红细胞生成素治疗癌性贫血疗效观察

目的探讨促红细胞生成素（EPO）治疗恶性肿瘤化疗后贫血患者的临床疗效。方法将41例恶性肿瘤化疗后贫血的患者分为观察组（21例）和对照组（20例）,两组均接受2个周期的化疗。观察组在每1个化疗周期结束48h后给予EPO12000U皮下注射,3次／周,连续3周,共用6周。两组的辅助治疗相同。于第2个周期的EPO治疗结束后评价疗效。结果EPO治疗6周后,观察组的血红蛋白水平、血细胞比容、红细胞计数均较治疗前有明显上升,差异有统计学意义（P〈0．01）。对照组化疗前后血红蛋白水平、血细胞比容、红细胞计数的变化不明显。结论EPO能改善化疗相关性贫血,提高肿瘤患者的生活质量,值得临床推广应用。     

骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者的影响

目的探讨骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者血甲状旁腺激素（PTH）、钙、磷水平的影响。方法将22例维持性血液透析继发性甲状旁腺功能亢进患者进行长时血液透析治疗,3次／周,每次6h。同时口服骨化三醇1I,zg／次,3次／周,共治疗3个月。分别于治疗前和治疗后检测血PTH、钙及磷水平。结果患者治疗后血PTH和血磷较治疗前明显下降[（484．21±230．18）nmol／L比（750．53±327．41）nmol／L、（1．49±0．27）mmol/L比（2．37±0．76）mmol／L],血钙较治疗前明显上升[（2．35±0．32）mmol／L比（1．81±0．53）mmol／L],差异均有统计学意义（P〈0．05）。结论骨化三醇联合长时血液透析可以降低维持性血液透析继发性甲状旁腺功能亢进患者血磷及血PTH,升高血钙,对治疗维持性血液透析继发性甲状旁腺功能亢进有一定的疗效。     

农村地区婴幼儿离乳食的干预研究

目的探索我国农村地区2岁以下婴幼儿离乳期家庭膳食改善方法,观察离乳食干预对预防儿童营养性贫血的短期效果。方法本研究对赵县农村6~11月龄儿童家长进行增加瘦肉摄入和增加蔬菜摄入的健康教育,评估干预措施改善婴幼儿的喂养行为和升高血红蛋白(Hb)浓度的效果。结果干预组和对照组分别有149和114名儿童完成了6个月的干预和随访。相对于入选时,3个月随访时干预组的儿童自身Hb浓度升高值为(2.65±14.38)g/L,高于对照组[(-0.18±11.21)g/L],差异无统计学意义(P=0.074);6个月随访时干预组升高为(8.33±15.85)g/L,高于对照组[(4.32±14.00)g/L],差异有统计学意义(P=0.034)。3个月随访时干预组的儿童的食物种类多样率(89.9%)高于对照组(78.9%),差异具有统计学意义(P=0.014);而6个月随访时,干预组(83.1%)与对照组(86.8%)的差异无统计学意义(P=0.405)。干预组的儿童3个月和6个月随访时24h瘦肉食入量[依次为(6.94±9.07)g和(7.96±13.90)g]皆高于对照组[依次为(2.42±6.10)g和(4.54±9.19)g],差异具有统计学意义(P=0.000和P=0.024)。结论通过家庭膳食干预,离乳期儿童的食物种类和瘦肉食入增加,Hb水平显著提高,营养性贫血患病率降低。儿童24h瘦肉食入量有所增加,虽然仍低于我国和发达国家的推荐量,但是营养改善效果已经明确初显。     

The effect of altitude change on anemia treatment response in hemodialysis patients

Hemodialysis patients who live at high altitude use less exogenous erythropoietin but achieve higher hematocrit levels than those living at a lower altitude. The authors hypothesized that the effect of altitude would be strongest in hemodialysis patients with poor anemia treatment response. To explore this hypothesis, they studied anemia-related outcomes in US hemodialysis patients who move to higher altitudes. Using Medicare and US Geological Survey data, in 1992-2004 they identified instances in which a patient moved from a dialysis center at an altitude of <2,000 feet (600 m) to one at a higher elevation. Of these moves, 5,274 were ≥3,000 feet (900 m; the altitude group) and 25,345 were 250-500 feet (75-150 m; the control group). Among patients with poor treatment response at baseline, large increases in hematocrit and decreases in erythropoietin dosing were observed in the altitude relative to the control group. At 6 months, hematocrit had increased more in the altitude group (5.1%, 95% confidence interval (CI): 4.1, 6.2 vs. 3.7%, 95% CI: 3.5, 3.9), and erythropoietin dosing decreased more (4,600 units/week, 95% CI: 500, 8,700 vs. 1,700 units/week, 95% CI: 1,000, 2,400). No effect of altitude was observed in patients with better treatment response at baseline. These results support the hypothesis that altitude-induced hypoxia reduces erythropoietin requirements in hemodialysis patients with treatment-refractory anemia.     

重组人促红细胞生成素在肿瘤相关性贫血中的临床应用

目的 探讨重组人促红细胞生成素（rhEPO）在治疗肿瘤相关性贫血中的临床疗效.方法 选择46例肿瘤相关性贫血患者,经皮下注射rhEPO 10 000 U每周3次治疗,无反应者增加至20000 U每周3次,4～6周为1个疗程.结果 28例患者经治疗后血红蛋白（Hb）明显上升,有效率为60.87％（28/46）.治疗前Hb为（67.45±2.05） g/L,治疗2周后为（71.05±1.73）g/L,治疗4周后为（78.45±2.20） g/L,治疗6周后为（90.65±3.42）g/L,差异有统计学意义（F=17.702,P＜ 0.05）.且随着治疗时间的延长,Hb水平逐渐升高,除治疗前与治疗2周后比较差异无统计学意义外,其余各时间点两两比较差异均有统计学意义（P＜0.05）.治疗后患者临床症状均有所好转,偶有头晕、乏力.治疗前KPS评分为40～70分,治疗后为60～90分,较治疗前显著提高.结论 应用rhEPO治疗肿瘤相关性贫血疗效明显,能有效提高Hb水平,改善患者生活质量.     

子宫内膜异位症患者腹腔液中EPO及ENA-78的表达及意义

目的研究促红细胞生成素（EPO）及中性粒细胞激活肽-78（ENA-78）在子宫内膜异位症（内异症）中的表达及意义。方法选择30例内异症患者（I—II期9例,III～IV期21例）和30例非内异症患者,采用双抗体夹心酶联免疫分析方法（ELISA法）测定其腹腔液中EPO及ENA-78的表达量,并分析内异症患者腹腔液中EPO与腹腔液中ENA-78的表达的相关性。结果内异症患者腹腔液中EPO及ENA-78的表达量[（9．272±2．284）IU／L,（2．068±0．794）ng／m1]均高于对照组[（5．759±0．502）IU／L,（0．886±0．145）ng／ml,P〈0．05];I～Ⅱ期内异症患者腹腔液中EPO的表达量[（9．549±1．996）IU／L]与Ⅲ～Ⅳ期患者[（9．181±1．897）IU／L]比较差异无统计学意义（P〉0．05）;III-Ⅳ期内异症患者腹腔液中ENA-78表达量[（2．517±0．518）ng／ml]高于I-Ⅱ期患者[（1．137±0．169）ng／ml,P〈0．05];内异症患者腹腔液中EPO与ENA-78的表达无明显相关（P〉0．05）。结论内异症患者腹腔液中EPO及ENA-78的过度表达,可能在内异症发病机制中起重要作用。     

左卡尼汀对维持性血液透析患者血浆可溶性肿瘤坏死因子样凋亡弱诱导因子蛋白的影响

目的 观察左卡尼汀对维持性血液透析（MHD）患者血浆可溶性肿瘤坏死因子样凋亡弱诱导因子（sTWEAK）蛋白的影响.方法 选择46例MHD患者作为MHD组,另选择同期健康体检者40例作为对照组.采用酶联免疫吸附法（ELISA）检测血浆sTWEAK、高敏C反应蛋白（hs-CRP）、白细胞介素（IL）-6及血浆胰岛素样生长因子（IGF）-1水平.26例血浆sTWEAK蛋白水平高于对照组平均值的MHD患者作为治疗组,20例低于或等于对照组平均值的MHD患者作为未治疗组.治疗组给予左卡尼汀1.0 g加入0.9％氯化钠溶液20 ml每周1次血液透析后静脉推注,治疗3个月后观察sTWEAK、IGF-1、握力及蛋白能量消耗（PEW）等变化.结果 MHD组血浆sTWEAK蛋白、IL-6、hs-CRP均高于对照组[（464±102） ng/L比（346±159） ng/L、（986.54±123.12） ng/L比（407.12±180.25） ng/L、（18.8±2.9） mg/L比（1.0±1.2） mg/L],差异有统计学意义（P＜0.01）.与未治疗组比较,治疗组治疗3个月后血浆sTWEAK蛋白、IL-6、hs-CRP明显下降[（126±92） ng/L比（243±103） ng/L、（799.45±105.34） ng/L比（966.04±113.11）ng/L、（13.7±1.9） mg/L比（26.8±2.8）mg/L],IGF-1明显升高,握力增加,PEW改善,差异均有统计学意义（P＜0.01或＜0.05）.治疗组体质量指数虽较未治疗组增加,但比较差异无统计学意义（P＞0.05）.结论 左卡尼汀可降低MHD患者血浆sTWEAK蛋白水平,减轻炎性反应状态,提高IGF-1水平,增加握力,改善PEW.